Constitutional Advancement of Growth Is Associated with Early Puberty in Girls

Papadimitriou, Anastasios; Kanakis, George; Douros, Konstantinos; Papadimitriou, Dimitrios T; Boutsiadis, Anastasios; Nicolaidou, Polyxeni; Fretzayas, Andrew

doi:10.1159/000330005

Cited by 10 publications

(4 citation statements)

References 24 publications

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“…Most children with non-FTS show an advanced BA and can be labeled CAG. We have shown that their PAH is not different from that of children with FTS, confirming previous observations ( 1 , 31 ). In our opinion, BA assessment remains an important tool in the differential diagnosis of tall stature.…”

Section: Discussionsupporting

confidence: 92%

Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

Stalman¹,

Pons²,

Wit³

et al. 2015

Jcrpe

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Objective:No evidence-based guideline has been published about optimal referral criteria and diagnostic work-up for tall stature in children. The aim of our study was to describe auxological and clinical characteristics of a cohort of children referred for tall stature, to identify potential candidates for adult height reduction, and to use these observations for developing a simple algorithm for diagnostic work-up and follow-up in clinical practice.Methods:Data regarding family and medical history, auxological measurements, bone age development, physical examination, additional diagnostic work-up, and final diagnosis were collected from all children referred for tall stature, irrespective of their actual height standard deviation score (HSDS). Predicted adult height (PAH) was calculated in children above 10 years. Characteristics of patients with an indication for adult height reduction were determined.Results:Hundred thirty-two children (43 boys) with a mean ± SD age of 10.9±3.2 (range 0.5-16.9) years were included in the study. Fifty percent of the referred children had an HSDS ≤2.0 (n=66). Two pathological cases (1.5%) were found (HSDS 2.3 and 0.9). Tall children without pathology were diagnosed as idiopathic tall, further classified as familial tall stature (80%), constitutional advancement of growth (5%), or unexplained non-familial tall stature (15%). Of the 74 children in whom PAH was calculated, epiphysiodesis was considered in six (8%) and performed in four (5%) patients.Conclusion:The incidence of pathology was very low in children referred for tall stature, and few children were potential candidates for adult height reduction. We propose a simple diagnostic algorithm for clinical practice.

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Section: Discussionsupporting

confidence: 92%

Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

Stalman¹,

Pons²,

Wit³

et al. 2015

Jcrpe

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“…administration of gonadorelin 100 μg/m 2 –max 100 μg (Relefact LHRH ® , Ferring SAS)] associated with elevated basal E 2 ≥ 15 pg/mL and pubertal configuration of the internal genitalia on the pelvic ultrasound: maximum uterine length ≥35 mm, pear shaped (uterine/cervix width >1), ovaries ≥3 mL with the presence of stimulated follicles ≥6 mm in diameter). BA was advanced more than the expected difference in years between their height percentile and their TH percentile, as these girls did not follow the well-recognized pattern of constitutional advancement of growth and puberty (CAG) [ 25 ]. Girls in Center-B were offered inhibition of puberty with leuprorelin and those in Center-A inhibition of puberty with leuprorelin combined to the AI anastrozole.…”

Section: Methodsmentioning

confidence: 99%

Anastrozole plus leuprorelin in early maturing girls with compromised growth: the “GAIL” study

Papadimitriou

Dermitzaki

Papagianni

et al. 2015

J Endocrinol Invest

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PurposeAromatase inhibitors have been used to increase predicted adult height (PAH) in boys but in girls only in McCune-Albright syndrome. We investigated whether anastrozole combined with leuprorelin for up to 2 years is safe and effective in improving PAH in girls with early puberty and compromised growth, compared to leuprorelin alone.MethodsThe “GAIL” study: girls treated with an aromatase inhibitor and an LHRH analogue, ISRCTN11469487, was a 7-year prospective phase IIa study with parallel design, performed at Athens Medical Center (C-A), and Attikon University Hospital, Athens, Greece (C-B). Forty girls, consecutively referred for early puberty (onset 7.5–9 years) with a PAH <−2 or >1.5 SD lower than their target height (TH), were included. Twenty started on leuprorelin sc/im 0.3 mg/kg/month plus anastrozole 1 mg/d p.o. (group-A, C-A) and 20 on leuprorelin (group-B, C-B) for 2 years or until the age of 10 years. Groups did not differ in age, height, BMI, bone age advancement (BAA), and distance of PAH from TH. Follow-up was at 6, 12, 18, and 24 m.ResultsReduction in BAA was significantly higher in group-A compared to group-B already by 6 m. Despite the transiently significant decrease in height velocity in group-A, gain in PAH SD was almost double by 12 and 18 m vs group-B and reached the maximum of +1.21 ± 0.45 (7.51 cm) vs +0.31 ± 0.37 (1.92 cm, p = 0.001) in group-B at 24 m. Group-A had no clinical or biochemical hyperandrogenism, unchanged normal bone density, and lumbar spine X-rays.ConclusionThe co-administration of anastrozole with leuprorelin safely improves PAH in girls with compromised growth.

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“…It is worth adding that, among girls experiencing idiopathic precocious puberty, the pattern of constitutional advancement of growth is commonly observed [ 91 ]. It is associated with early puberty and marked by accelerated early-stage growth, peaking in the initial 2–4 years of life [ 92 ].…”

Section: Non-metabolic Complications Of Obesity In Childrenmentioning

confidence: 99%

Not Only Metabolic Complications of Childhood Obesity

Ciężki,

Odyjewska,

Bossowski

et al. 2024

Nutrients

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The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

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Constitutional Advancement of Growth Is Associated with Early Puberty in Girls

Cited by 10 publications

References 24 publications

Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

Anastrozole plus leuprorelin in early maturing girls with compromised growth: the “GAIL” study

Not Only Metabolic Complications of Childhood Obesity

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